Abstract 18114: Continuous Flow LVAD Technology Has Influenced Wait Times and Impacted Donor Allocation in Cardiac Transplantation
Introduction: Bridge to transplantation (BTT) patients with continuous flow Left Ventricular Assist Devices (cfLVAD) are assigned UNOS Status 1A or 1B priority while awaiting heart transplantation (OHT). The influence of cfLVAD on waitlist times and organ allocation was investigated.
Hypothesis: We hypothesized that cfLVAD patients on the waitlist live longer, allowing them to wait for more favorable donors.
Methods: The UNOS database was examined from 2005-2012 for all OHTs. The pulsatile flow (pLVAD) era (2005-2008) was compared to the cfLVAD era (2009-2012). The majority of LVADs placed during these 2 eras were corroborated to be pLVAD and cfLVAD respectively. These 2 cohorts were compared to patients that did not receive LVAD.
Results: Of 16,476 total OHT, 3,270 (19.8%) were BTT. From 2005-2008, 1,389 (16.3%) of OHT were BTT, while from 2009-2012, 1,881 (23.7%) were BTT, marking broader acceptance of device technology (p<0.001). The cfLVAD recipients were older, more often diabetic, and had higher serum creatinine (table). The cfLVAD cohort spent 44.0 days as status 1A while pLVAD patients spent 9.8 days and non-LVAD patients spent 16.4 days as status 1A (p<0.001). The cfLVAD group spent 117.4 numbers of days as status 1B, while the pLVAD cohort spent 104.8 days and non-LVAD group spent 121.7 days in status 1B (p<0.001). One-year waitlist survival was highest in the cfLVAD era (77.5%), as compared to the pLVAD (54.1%) and non-LVAD cohorts (53.6%) (p<0.001). The cfLVAD cohort received older, more male donors that had higher BMI. Ischemic time was lowest in the cfLVAD group. One year post-transplant survival was highest in non-LVAD (91.4%) as compared to cfLVAD (91.0%) and pLVAD patients (87.2%) (p<0.001).
Conclusion: Despite being older and less favorable recipients, cfLVAD patients spend more time as status 1A and have higher waitlist survival. This may allow cfLVAD patients to receive preferred donor hearts, which may explain their higher post-transplant survival.
- © 2013 by American Heart Association, Inc.